Provider Demographics
NPI:1003964271
Name:POHL-Y-BACA, JULIETTE EILEEN (PHYCIAN ASST -CERT)
Entity Type:Individual
Prefix:MRS
First Name:JULIETTE
Middle Name:EILEEN
Last Name:POHL-Y-BACA
Suffix:
Gender:F
Credentials:PHYCIAN ASST -CERT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31116 5TH WAY S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4049
Mailing Address - Country:US
Mailing Address - Phone:253-839-8326
Mailing Address - Fax:
Practice Address - Street 1:233 2ND AVE S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5852
Practice Address - Country:US
Practice Address - Phone:206-436-6380
Practice Address - Fax:206-436-6385
Is Sole Proprietor?:No
Enumeration Date:2007-01-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA1003502363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMP0259259OtherDEA NUMBER